Acute pain teams and postoperative pain

Clinical bottom line

There is no good evidence that the introduction of acute pain services make a difference to acute pain after operation.

Reference

A McDonnell et al. Acute pain teams and the management of postoperative pain: a systematic review and meta-analysis. Journal of Advanced Nursing 2003 41: 261-273.

Background

Acute pain teams are now common in hospitals, and their introduction in UK hospitals has been recommended to reduce postoperative pain. It is not well understood how effective they are, and how they should be resourced and organised to yield the best results.

Systematic review

A broad search strategy examined seven electronic databases, and hand searching of a number of journals, and expert bodies were consulted.

Results

There were 15 eligible studies. None was randomised, 12 were uncontrolled before-after studies, and in nine the data collection was for clinical audit purposes. Pain was measured in nine studies and nausea in five.

Four groups of different operations in one study (245 patients) examined pain in the first 24 hours and found less pain with an acute pain service. Four studies (703 patients) examined pain in the first 24 hours and found a bare statistical significance, but only with a fixed effects, and not a random effects model.

Comment

The evidence for acute pain services is weak. Most studies were or poor methodological quality, and only nine measured pain, with only four of these with information that could be used in a meta-analysis looking at pain in the first 24 hours after surgery.

This just isn't good enough. While many of us would like to believe that acute pain services are an important part of improving hospital care, we need to know what elements of the service make it effective. It isn't just doing something, but doing that something effectively.